Doctors driving rising rates of caesareans, surveys find

Rising caesarean rates are driven by doctors, not women, and almost one in 10 patients are not consulted about the risks and consequences of the surgery, according to Queensland researchers.

The results of three surveys of 14,000 women confound views that soaring rates of caesareans in private hospitals are because of differences in women's ages, risks or that they are ''too posh to push''.

'We have to stop blaming women because it's clear that they aren't driving this.' Photo: iStockphoto

Yvette Miller, lead author and senior lecturer in public health at the Queensland University of Technology, said she was surprised women's preferences had ''no role to play'' and that many acted on advice from doctors without being properly informed.

''An equal number of women want a natural birth in private and public sectors, but in private there's a higher proportion of women saying they were only allowed a caesarean,'' Dr Miller said.

''We're unsure what motivates doctors' decisions, it could be financial incentives, convenience or a different approach to risk in private and public sectors.''

Dr Miller is now researching the reasons for the recommendations.

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One survey, published in BMC Pregnancy and Childbirth, found more than 10 per cent of women were uninformed about the risks of emergency caesareans and epidurals, and about one quarter were not consulted before having an episiotomy. Sixty per cent were not adequately informed about vaginal examinations and 21.9 per cent were not consulted or informed before having an ultrasound.

''Women need to be involved in decisions because their values about the risks could be different from the health practitioner,'' Dr Miller said. ''These are decisions that need to be made in partnership with their doctor or midwife.''

She said the highest rates for lack of consultation were for ''routine'' procedures, such as ultrasounds and vaginal exams.

''If you don't involve the patient then doctors are likely to make a poor-quality decision that might not reflect the patient's values.''

In Queensland, decisions about risks in labour were made pre-emptively, she said, whereas in Britain, where caesarean rates are about 24 per cent, they were ''more likely to wait for a real indicator something is wrong''.

Australian College of Midwives spokeswoman Hannah Dahlen said health practitioners ''always have time'' to inform and involve women in decisions.

''Frankly this mantra that women are fat, old and that they are asking for caesareans has got to stop,'' she said. ''We have to stop blaming women because it's clear that they aren't driving this. It's inexcusable that often women are provided with limited options.''

Almost one-third of all births in Australia in 2011 were caesareans, according to an Australian Institute of Health and Welfare report. This was up from 27 per cent in 2002 and 18 per cent in 1991.